Accuracy of caudal epidural injection: the importance of real-time imaging

Caudal epidural steroid injections are often used for low back pain. Fluoroscopic guidance has been frequently cited as a requirement for this procedure. In this preliminary report, we demonstrate that fluoroscopic guidance for caudal epidural Tuohy needle placement without real-time imaging may result in inadvertent intravenous injection of the drug. We detected intravenous leakage of the drug in 4 cases of 10 when real-time fluoroscopic imaging was used. Thus, real-time imaging may be recommended in addition to routine fluoroscopic guidance for caudal epidural procedures, as it may improve efficacy and safety by assuring accurate drug deposition.